The Empathic Ward: Reality and Resistance in Mental Health Reform

Article excerpt

This article provides perspective on our experiment to change a psychiatric hospital ward from reliance on drug therapy to psychological treatment. Resistances to the change took many forms, including delaying publication of the results for nearly a decade. Although successful, the treatment program itself was never adopted. The work did have a major impact on the "right to refuse treatment" case originally titled Rogers v. Okin (1979), which barred forced medication and involuntary seclusion except in certain emergencies if an outside consultant agreed. Two publications (Deikman & Whitaker, 1979; Whitaker & Deikman, 1980) described much of the program and its vicissitudes but did not include some of the more resisted features reported in this article.

The purpose of this article is to provide perspective on our previous successful experiment to change a psychiatric hospital ward from the practice of relying on drug therapy to relying on psychological treatment. Although achieving our goal of improving treatment outcomes for severe mentally disturbed persons, we encountered severe resistance to accepting our reports as valid. The resistance took many forms, but one result was that we were not able to publish our observations and results for nearly a decade (Deikman & Whitaker, 1979; Whitaker & Deikman, 1980).

Our findings aroused an antagonism for which we were not prepared. For example, when we submitted the first article to a major psychiatric journal, two of six reviewers refused even to read our manuscript. The reviewers believed that not using drug treatment for such patients was unacceptable, perhaps even malpractice. Eventually, we circulated our unpublished manuscripts to a few colleagues, one of whom, Michigan State University professor, Bertram Karon, suggested submitting the manuscript to a psychology journal, which we did. The result was that the articles were finally published in Psychotherapy: Theory, Research and Practice, an American Psychological Association Journal.

However, the manuscripts did strike a chord with some professionals. As a result, even before publication, Dr. Whitaker was asked to be a consultant to a VA hospital, to be an expert witness in the "right to refuse treatment case" in Boston's U.S. District Court, to propose a new Massachusetts state mental health plan, and to become superintendent of a state hospital. Publication of our two articles brought about 400 reprint requests, including many from foreign countries.

But the treatment program itself has never been adopted. Nor did it appear to have any effect on the tidal wave of drug treatment that has taken place in the United States and throughout the industrialized world, despite evidence of drug induced damage on the one hand and superior results for interpersonal forms of caring on the other. There has been one hopeful development: The right to refuse treatment case, originally titled Rogers v. Okin (1979) set a precedent to disallow forced medication or involuntary seclusion except in certain emergencies and then only if an independent outside consultant agreed.

In the present article, besides reviewing our ward program efforts, the nature of the helping processes, and how staff and patients alike were challenged, we try to explain how the more serious personal and institutional resistances can be understood. Along the way, we shall disclose material we felt unable to publish earlier, including more of the evolution of power and responsibility sharing with the patients. We start by relating how we came to think of operating such a program. We anticipated resistance, but we did not know just what kind of resistance would emerge.

BEFORE THE WARD

Dr. Whitaker had been serving one of the several psychiatric wards and supervising other psychologists working in the hospital and in the outpatient clinic. …